The risk of developing coronary artery disease or congestive heart failure, and overall mortality, in type 2 diabetic patients receiving rosiglitazone, pioglitazone, metformin, or sulfonylureas: a retrospective analysis
Tóm tắt
Oral anti-diabetic agents have been associated with adverse cardiovascular events in type 2 diabetes (DM2). We investigated the risk of coronary artery disease (CAD), congestive heart failure (CHF), and mortality using multivariable Cox models in a retrospective cohort of 20,450 DM2 patients from our electronic health record (EHR). We observed no differences in CAD risk among the agents. Metformin was associated with a reduced risk of CHF (HR 0.76, 95% CI 0.64–0.91) and mortality (HR 0.54, 95% CI 0.46–0.64) when compared to sulfonylurea. Pioglitazone was also associated with a lower risk of mortality when compared to sulfonylurea (HR 0.59, 95% CI 0.43–0.81). No other significant differences were found between the oral agents. In conclusions, our results did not identify an increased CAD risk with rosiglitazone in clinical practice. However, the results do reinforce a possible increased risk of adverse events in DM2 patients prescribed sulfonylureas.
Tài liệu tham khảo
The University Group Diabetes Program (1975) A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. V. Evaluation of pheniformin therapy. Diabetes 24(Suppl 1):65–184
UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352(9131):837–853
UK Prospective Diabetes Study (UKPDS) Group (1998) Effect of intensive blood–glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352(9131):854–865
Nissen SE, Wolski K (2007) Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 356(24):2457–2471
GlaxoSmithKline (2007) Study no. ZM2005/00181/01: Avandia Cardiovascular Event Modeling Project. Available at: http://ctr.gsk.co.uk/Summary/Rosiglitazone/III_CVmodeling.pdf. Accessed 15 Sept 2007
Singh S, Loke YK, Furberg CD (2007) Long-term risk of cardiovascular events with rosiglitazone: a meta-analysis. JAMA 298(10):1189–1195
Lipscombe LL, Gomes T, Levesque LE et al (2007) Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. JAMA 298(22):2634–2643
Home PD, Pocock SJ, Beck-Nielsen H et al (2007) Rosiglitazone evaluated for cardiovascular outcomes––an interim analysis. N Engl J Med 357(1):28–38
McAfee AT, Koro C, Landon J et al (2007) Coronary heart disease outcomes in patients receiving antidiabetic agents. Pharmacoepidemiol Drug Saf 16(7):711–725
Dormandy JA, Charbonnel B, Eckland DJ et al (2005) Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 366(9493):1279–1289
Lincoff AM, Wolski K, Nicholls SJ et al (2007) Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA 298(10):1180–1188
Nissen SE, Nicholls SJ, Wolski K et al (2008) Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized controlled trial. JAMA 299(13):1561–1573
Gerstein HC, Yusuf S, Bosch J et al, DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators (2006) Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet 368 (9541):1096–1105
Kahn SE, Haffner SM, Heise MA et al (2006) Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 355(23):2427–2443
Lago RM, Singh PP, Nesto RW (2007) Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials. Lancet 370(9593):1129–1136
Maru S, Koch GG, Stender M et al (2005) Antidiabetic drugs and heart failure risk in patients with type 2 diabetes in the UK primary care setting. Diabetes Care 28(1):20–26
Koro CE, Bowlin SJ, Weiss SR (2005) Antidiabetic therapy and the risk of heart failure in type 2 diabetic patients: an independent effect or confounding by indication. Pharmacoepidemiol Drug Saf 14(10):697–703
Johnson JA, Majumdar SR, Simpson SH et al (2002) Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes. Diabetes Care 25(12):2244–2248
Bell DS (2006) Do sulfonylurea drugs increase the risk of cardiac events? CMAJ 174(2):185–186
Krentz AJ (2003) Sulfonylureas in the prevention of vascular complications: from UKPDS to ADVANCE study. Int Congr Ser 1253:261–277
Monami M, Balzi D, Lamanna C, Barchielli A, Masotti G, Buiatti E, Marchionni N, Mannucci E (2007) Are sulphonylureas all the same? A cohort study on cardiovascular and cancer-related mortality. Diabetes Metab Res Rev 23(6):479–484
Monami M, Luzzi C, Lamanna C, Chiasserini V, Addante F, Desideri CM, Masotti G, Marchionni N, Mannucci E (2006) Three-year mortality in diabetic patients treated with different combinations of insulin secretagogues and metformin. Diabetes Metab Res Rev 22(6):477–482
Evans JM, Ogston SA, Reimann F, Gribble FM, Morris AD, Pearson ER (2008) No differences in mortality between users of pancreatic-specific and non-pancreatic-specific sulphonylureas: a cohort analysis. Diabetes Obes Metab 10(4):350–352